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tv   Charlie Rose  Bloomberg  February 26, 2015 7:00pm-8:01pm EST

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>> from our studios in new york city, this is "charlie rose." >> an estimated 1.6 cases of
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cancer will be diagnosed in 2015. there is increasing hope for those touched by the disease. city of hope is a rish ren -- research center in california. turning me now is robert stone. the ceo. he served as provost and scientific officer. and stephen foreman he also serves as chair of hematology. i am excited to have them here. because of all the lives that have been touched. let me begin by talking about the city of hope. >> thank you for having us. we are one of the top cancer centers in the country.
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one of only a handful independent and designated by the national cancer hence -- institute as a comprehensive center. eye doctors and physicians are -- are doctors and physicians are experts. we got started more than 100 years ago. we started as a tuberculosis sanatorium on the outskirts of the desert in california. as we look today, there are 17 million people who live within an hour drive of duarte. 20 minutes from downtown los angeles. 100 years ago, it was the desert and the end of the train stop. a garment worker saw someone die in the streets of los angeles. decided no one should die alone.
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formed, took money out. formed a tuberculosis sanatorium. we started with hope that that has stayed with us to this day. to understand us completely, you need to know where applied science meets a patient and family experience. a founder penned our credo that stays with us. there is no profit in curing the body if any process we destroy the soul. >> destroy the sole means what? >> treating everyone with dignity. as an individual. so much of the work that the
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doctors and their colleagues do is dealing with people who are at a crisis of life. it is a clinical approach. making sure their families are taking care of. >> let me know where br with cancer research. where are we meeting with success? >> there has been a revolution not just in the therapies. but radiation therapy. entities that no longer require incisions, healing. chemotherapeutic techniques are
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still effective. the most advances have been biological approaches. where you know the molecule that you want to interfere with and you can kill the cancer as a result of disrupting it. i gave a presentation and had listed a dozen different alternatives. therapy that you will hear about. these are exciting, of all been and have had a profound effect on the clinic. most importantly, with modest toxicity. >> what is the biggest challenge researchers face? >> the challenge of understanding the cancer cells has been the lights work for
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many people across the u.s.. that is what has revealed the clues we used to determine targeted therapies. immune-based therapies. last year, on the cover of "science" magazine, in you therapy -- immuntherapy is the fourth partner in how we treat cancer. using the immune system to help in the fight. that has been derived from the sick research. i will tell patients that there is no therapy we were using that was not arrived from some idea in a laboratory working late into the night. the other challenge is maintaining funding so all ideas get a chance to help someone. >> finding funding for someone
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working late into the night. >> we have been doing this for a long enough time we are always sometimes painfully aware of what we can do now had we known it then. who would be with us today. there is a certain tyranny of time that comes with our work. why we want to move faster. as robert was saying, one of the things we pride ourselves is trying to take the idea and move it as quickly to the bedside. people come to us and other cancer hospitals for that purpose. >> how long does that process take? >> from idea to a drug has been 7-10 years. what we try to do is shorten that as quickly as we can.
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partnering with pharmaceuticals, other cancer centers. the patient is looking at you that day. that is part of the personal -- people talk about personalized medicine. there is the idea we want to give you the right there for the right gene in the right cancer you might have. but not at the expense of the personalizing the experience. for all of us who take care of people with cancer, it is a person-to-person relationship. and we are grateful for the trust they place an us to take care of them or their family member. it is more than a one of the big -- >> what are the big questions we don't know? >> we have started to understand the genetic combinations. genes expressed and jeans not expressed. what understands -- regulates
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the expression of these genes. the key proteins responsible for whether a cancer divides or invades or spreads to another organ. this knowledge is allowing us to create strategies that will allow for both more effective therapy's. also prevention strategies. once you know what gene may be associated with a cancer you may be able to say, if someone carries the gene, how can we event it from developing? >> how are we doing that? >> probably be best example would be the genes in breast cancer can read if you have a high risk. there are a variety of difficult decisions you might have to make that range from having a mastectomy two very active surveillance. taking a hormone that may decrease the risk. >> the complex city of how many genes affect people has always been one of the huge mountains
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to climb. according to my understanding. what made it feasible for you to do what you did was in part because you are talking about one gene. >> there is a disease that is the poster child for cancer herpes. it is a leukemia. many people have worked on it and found there was a single gene mutation that drove the cell to become leukemic. it also gave an opportunity for other people to develop a drug that works for that disease. the problem is that it is a wonderful story. it saves a lot of people's lives. it made other therapies unnecessary in some cases. most cancers are not a single gene disease. to focus on one gene i think we have all learned how invasive
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and tricky be cancer cell is. it is a battle that is ongoing. >> do cancer cells get smarter? as you develop therapies, they get smarter? >> unfortunately that is the case. that either -- they either co-opt parts of the body for their purposes. or for any drug, they figure out ways around it. either by selection. it kills out most of -- off most of the cancer but not all of it. or the cell mutates again. which is often why we do things in multiples to try to box it in. >> was the breakdown between genetic and environmental? >> it has been said 20-30% of
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cancers have a direct genetic link. environment plays a very significant role. tobacco that was the number one cause of cancer related deaths. now we have an epidemic in obesity. the concern that the cancer incidence as a result of obesity will exceed that of tobacco use. sexually transmitted diseases associated with cancer. human papilloma virus. hepatitis. son. melanoma. -- sun, melanoma. sun exposure. >> prevention, there were three cancers in particular. sun. hpv vaccine, if we vaccinated
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everybody before the age of 10, we would eliminate head and neck cancer. half of them are hpv related. >> if everybody was vaccinated before they were 10. >> the diseases would become negligible. that is why when we have talked to parents about the hpv vaccine, the parents were hesitant to. we helped them explain to their children, even though was a sexually transmitted disease, this was a cancer prevention. parents and kids were more comfortable. that is why we pushed so hard for this to be part of what kids get. it is ultimately down the line. >> hepatitis b would be similar.
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vaccines for that that we give kids. worldwide, we could affect liver cancer in a major way. that's the context of prevention. >> turning back to the institution. what is your message about the city of hope? >> everybody is touched by cancer. they don't appreciate what it takes to actually move the treatment field forward. education is part of it. raising funds, going around the country. we are blessed with a network of volunteers and donors that runs in the hundreds of thousands across the country. they provide resources and donations to fund research that would not have other fundies >> -- funding sources. >> components have existed for
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many years. when i think of precision medicine, it is personalized. based on the signature of the individual termiumor/ that is based on the genes that are mutated and expressed. in breast cancer, if you express -- we use proteins are the. we are able to dissect the genetic composition very rapidly and look for abnormalities that may potentially be targets for therapy. >> this has enormous potential in the short-term? >> it has a norm is potential but there are hurdles. not so much on defining the abnormalities but addressing the abnormalities.
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we have known the defect in sickle cell anemia for decades but have not been able to change the course of the disease. in concert with understanding the abnormalities in the cancer cell, we have to be developing more effective or could experiment >> what are the diseases that are most likely to respond to precision medicine? >> blood cancers often lead the way in terms of our being able to develop effective therapies. like leukemia. where there has been incredible progress in the last decade. in some cases, enhanced cures. and all most all cases improving quality of life in prolonging life. >> the potential for im munotherapy? >> that is the hot topic.
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in the last three years, that is when it has taken off. we were talking about anti-body therapy. the most effective antibodies who signs was developed at city of hope -- which were developed at city of hope, they have may be different in curing a lot of people. that was the first foray into immune-based therapy. there have been two things we have seen. taking a person's own selves out and modifying them. reprogramming them by introducing new genes that will target specific cancer. that has been incredibly exciting with patients who have done amazingly well. there was no other therapy to be done.
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we are working on trying to expand that to a number of diseases. the other has to do with what the cancer does anybody to quiet -- co-opt your system. we have been asked, why did the immune system not take care of this? cancer does things to prevent your immune system from reacting. there have been checkpoint in bidders. drugs that suppress the cancer' s affected to allowing her written have seen remarkable results in diseases that were hard to treat. melanoma and a lung cancer. to maximize the impact to develop t cells or other drugs that affect the so-called microenvironment and let your immune system do what it is
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intended. >> right now, the most radically results have been seeing in a certain type of leukemia. -- the most dramatic results have been seen in a certain type of leukemia. we are extending that to include rain cancer, breast cancer, cervical cancer. we want that to not be a one trick pony but a field. >> are you hopeful? >> we are. >> what is the question the trials will answer? >> whether the sell can cause remission in a person with brain cancer. >> is that possible? >> we do believe it is possible in preclinical work. we have seen cancers disappear. >> is it being used today?
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>> those trials are under fda supervision. >> the trial already has approval. >> all of these require fda approval. they are a partner of sorts in wanting us to do the right thing in the safest way possible. we are anxious to move as quickly as we can. we get calls. >> someone told me brain tumors are one of the most difficult to treat. >> that is true. in part because of its location. and the effect it has on a person with the cancer. some cancers, as you are asking, are more indolent in their behavior. you can live with it and keep it at the bait. brain cancer is not one of those at the present time. it grows rapidly. because it grows in a space -- it spread throughout the
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brain. what's the brain controls everything. >> it defines who we are. it is the seat of the soul. the seat of many things we define as our humanity. before, it has been predominantly surgery and radiation and a little bit of chemotherapy. now there is immune therapy. genetically engineered t cells injected directly into the brain to make it go away. >> let's talk about stem cell therapy. we take cells from a person. we put them into another person to change their blood from what it was. we do that predominantly to cure diseases like leukemia. lymphoma. it started in the 1970's. it has become a therapy that for
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some patients is the curative therapy for their disease. we do it with puritan intent. we try to rid of the cancer. the city of hope has a large program. people come to us for that particular therapy. when i first started, you did not do anybody over the age of 30. we routinely do it for people in their 70's and even early 80's. it is to replace a diseased immune system. >> is a called bone marrow transplants? what's it started out as we would remove cells from the bones. with research, we found they circulate in the bloodstream. we can collect them from the bloodstream to read >> would you say the stem cell is the silver bullet? in terms of dealing with cancer? >> it is predominately for
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diseases of the blood and immune system. cancers that we take care of. the therapy does not work that way. >> why? >> the cancers of the immune system are sensitive to this immunological effect. what we have done is taken the analogy of that immune system effect of the cancer. that is in part what led to the t cells. make the immune system only recognize the cancer as opposed to the whole body. developing engineered t cells that react against leukemia brain cancer, that is derived from the observation that the immune system can react against and cure cancer. what we want to do is make that as available as we can to everyone. in some situations, make still some -- stem cell transplant
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unnecessary. >> there is the idea of alternative therapies. i have had conversations. sometimes it brings up the name of stephen jobs. the walter isaacson book. a program i did with david kelly. who also had cancer and told me that steve told him, when david developed cancer, go get the toughest strongest treatment to can get. -- you can get. don't let yourself be fooled by alternative therapies. >> i think for those of us, it is in issue. people bring things to us. >> they pop up on the internet and everywhere else.
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there may very well be alternative therapies that have value. the point is, how you make sure you are not below the two -- l ulled into what might come under the umbra love to read >> some of them might help the individual get through. massage, acupuncture, mind-body approaches. nutrition is clearly key. where there is more controversy is the use of herbs. other compounds in that scope. there are side effects. they might not just work, they might cause toxicity. i have had experiences where well-meaning positions or friends have given an individual a specific herb to use income and nation with our therapy. they developed liver toxicity.
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-- well-meaning physicians or friends have given an individual a specific herb and they have developed liver toxicity. >> what will we be talking about? >> more people cured, moving on with their lives. what we have seen in the last 35 years says it can be done. >> has there been an increase in the velocity of results or not? >> i would say, without question. the patients i see. >> more technology. >> we gain more knowledge in a week than we used to gain in a year. >> information is more available. as steve points out, the challenges, although generic information we have. >>
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finding the right drug. >> we have talked about precision medicine, stem cells with blood lymphoma and leukemia. is there one breakthrough that will change the game totally? >> i think we would all be pursuing and if we knew the exact right through. there are at least a dozen approaches of thought more that hold promise -- if not more that hold promise and are of. >> do me some to there is a waste disposal -- give me some. >> there is a waste disposa l mechanism that is a home run for some cancers. a martha for lymphoma. if you have it on the surface of your cancer, we can put your
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disease in remission and cure a significant percentage. the field is rapidly evolving. some of the fields -- advances i would if never predicted have turned out to be remarkable. check point inhibitors. that took me by surprise. i never thought cancers were being attacked in human beings to the point where if you just interfered with the blockage you would see remissions. and yet brilliant scientists who have confidence in their work pushed it and pushed it and they were right. >> we often talk about, cancer is not one disease. it is 35 or 40 different diseases. on the other hand what steve is talking about, there are clues in one cancer that become a football to another. part of our jobs collectively are two not get so narrow any
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focus that we miss something that could be helpful. there are good examples of check point inhibitors which were found to be effective in the loma. -- melanoma and now in lung cancer. hodgkin's disease. the lymphoma. if we borrow from each other and learn from each other. >> is there enough talent in the field? >> there is enough talent. it is getting the talent to talk to each other and look at the problem from a different way. >> one thing about cancer centers, they are designed to be think tanks for all aspects of cancer from the molecular biology to the immunology.help ow a person gets back-and-forth to the hospital. in the context of a human suffering and doing things that will relieve it bike your --
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relieve it bike your taking care of them. >> take you for coming in. ♪
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>> there is no more important economic and political debate in
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america than what to do about the struggling and shrinking middle class. central players in the race will be -- david brooks calls him the preeminent young conservative policy individual. he is an advisor to paul ryan, marco rubio, and recently consulted with jeb bush. and hillary clinton's recent advisor. and then a top eight in the obama white house. now running the center for american progress. she has been called the sugar ray robinson of policy mavens as in pound for pound the best. we are pleased to welcome both of you. when we talk about the shrinking middle class, is it in him -- income inequality?
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how do you define it? >> mobility is the best way to think about it. both parties are coming around to rhetorically talk about mobility. for the democrats, that is a move from inequality to mobility. for republicans, from a abstract focus on growth. it remains largely to be seen how that will apply to policy. inequality is a good way to understand what is happening economically. it distorts more than it clarifies. growth is not enough. it is a prerequisite but not the sum and substance of what the middle class is missing. >> i think all those problems are a challenge. i'm good with the answer. social mobility, stagnant social mobility, is a challenge. i think we are suffering from
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massive inequality. what people are concerned about our stagnant wages. we have had trends creating downward pressure on wages. that is a more american phenomena than other countries i completely agree that social ability -- mobility is a challenge. but these are interlocking. wage stagnation is one of the reason people can't move up. >> social mobility is worse in america can read more of a problem in america than in canada or sweden. other places. it has gotten worse. >> it is a collocated story. -- complicated story.
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when you look at whether you moved to the top to bottom. it hasn't changed much but has been poor. a child born in poverty has a 30% chance of ever getting beyond the bottom. in less than 5% to get to the top. that has been true for several decades. we have a significant problem. america is not better than other developed countries. it is worse than some. worse than canada. you can also think about it in terms of absolute mobility. is your situation better than and was? better than your parents at your age? the picture is collocated. -- complicated. most americans are doing better
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than their parents, but not better than similarly situated people were 10 or 20 years ago. that is why it feels like running or place. >> what should government do about this? >> we have to impact that. there are two size of the wage squeeze. one is, do people have the tools they need to move up? an education challenge. also, are there economic risks they bear? health care and other issues? there is a role for government. i think we have broader challenges in the economy. we have companies, particularly in the last several years, which are very profitable. profits are sky high. they are doing very well relative to the rest of the world. but we don't have pressure in the economy to ensure workers benefit from those profits.
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unless they have a super, very tight labor market. we are trying to think through, you can -- are there roles for incentives with companies to ensure they have some incentive to ensure workers are doing well as well? that is a big challenge we have had. >> specifics? >> providing incentives to companies to profit share. high-value firms that have real investments in human capital generally supports economic growth and higher productivity. hopefully this is idea that both for conservatives and progressives can like. >> you may have trouble getting conservatives in your call for stronger unions. >> i can see how that might be an issue. >> why is that important? >> what other countries that
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have had economic growth and stronger prosperity for americans, where wages have gone up, they do have higher percentages of labor union precipitation -- participation. the reality is, lots of labor unions have had an impact. working-class workers. people below the 50%. >> i will jump in on that. -- yuval, jump in on that terrific >> both parties have been ignoring key realities of the 21st century. finding excuses to advance the agenda as they are used to. a lot of the economic debates have looked like that. the attempt -- they attempt to look at the america of the late
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20th century and make that america work. one of the important things that has changed in the century, the last 15 or 20 years, the beginning of a change not just in the economy but also the culture and media. a change from large institutions running things together to smaller networks enabling people to succeed. it is a long-term trend in american life. when we have not grown accustomed to currently think of america in terms of large institutions. big government, big media, working together. success looks like navigating them successfully. that is not the america we live in now. when a young person comes out of college and thinks about a career trajectory, that person is not looking for a job that will start him at a company where he will retire from 40 years later. nobody thinks that way. and yet love the way we think about labor and security against financial risk is still built for that world. >> greater worker rights, it
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doesn't have to be out labor unions -- about labor unions. >> i think it terms of how to improve, i think it is a bad idea on substance and does not get you very far. the first steps to take, if you want to the about the role of government in better enabling mobility, there is a prerequisite to read a precondition to meet economic growth. the parties agree. republicans tend to stop there, and that is a problem. we need more growth reacted policies, tax reform and entitlement reform. thinking about the kinds of pressures the government puts on the economy. beyond growth, government has to think about clearing bottlenecks. especially bottlenecks created by public policy. it is a certain kind of impediment to mobility. a narrowing of options. one to pick about is higher
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education. it should be a path into the middle class. it very often is a bottleneck anyway a success for people trying to improve their situation. it is a bottleneck because costs have grown while value has not increased. it is very hard to inject competition into higher education. have a system that is kind of stuck and costing more and more. people -- putting people into more debt but not value. >> costs are a problem, but don't most people think our system is good? >> it is good for people in the top institutions. there is no question it is worth it. is it worth three times more than it was in 1980 question mark that is what it cost -- 1980? that is what it costs. >> one of the things you have proposed is an increased child tax credit. $2500 per child. tell us why you think that is important.
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also, is it that republicans have focused too much on marginal tax rates? corporate tax breaks? mitt romney's concern about the top 1% or whatever? is this a change of emphasis, at least? >> i think it's a change of emphasis. those rates matter. marginal tax rates are important for economic growth. they are most problematic on the business side. the rubio proposal includes a very aggressive reform of the business tax code. tex reform has to include tax relief for working families. reported as having not done enough >>? -- republicans have not done enough? >> they have succeeded when they have done that. in the last few years, and about and have not talked about that kind of thing enough. an increase in the child credit
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is the right way to deliver relief. it allows people relief from payroll tax. parents are overtaxed in our system. the way that entitlement system interacts with the tax system means there is a kind of is intended to raise children. it is contracted some. there's more room to do that. -- counteracted some. there's more room to do that. that is a plausible, logical way to deliver meaningful tax relief. >> pick up on that. >> i think we could use a child tax credit. we call for a middle income credit karin >> will you endorse their proposal? >> certainly the child tax credit. that is one and area where government can help address the wage stagnation. i would say we have to look at how other countries that are
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flexible are managing to have wage growth. we are having challenges. we are more flexible. we are having some of these problems. i don't think the issue is, we don't want to regulate business. we went to make sure businesses are as innovative as they h ave ever been. the question is what is the social contract between business and workers and others? to say, we want you to be as profitable as possible. it is also important that there is hope for the middle class and others working hard have delivered higher productivity and are seeing no gain from that productivity. >> do the rich have to pay more? most of the gains have got the top 1%? you have to redistribute more to the middle and the lower?
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>> this is where i would disagree. i think his n.l. assistant is right. -- analysis is right that we have seen growing inequality. the challenge in the u.s. and other countries is not to come up with redistribution but pre-distribution. as a progressive, i would prefer good jobs families have good jobs that pay a decent wage. an increasing wage. then to just say, tax the rich to give to the middle and bottom. that over the long-term term is not only sustainable. from our perspective, we need an economic growth strategy. my concern about particular answers around social mobility. we probably have ranges of disagreements.
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we have to think about the social contract between business and workers. government can't specify the rules of the game. other countries have been able to manage they are as flexible as we are. they have managed to create norms in cultures where companies are profitable but also feel they have to share those gains. >> a larger role in the rules of the game? >> the micromanagement of the relations is -- relationships between countries and workers at this point is not what government should do to improve growth. we don't have enough growth to enable mobility. it is not easy to say how you get there. growth in the past 50 years was driven by growth of the labor force and growth of productivity. we are not going to have the they were force growth we had. it is not possible. you had women coming into the workforce and baby boomers. the men are there.
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-- women are there but that rate has plateaued. the baby boomers are retiring. the majority of growth is going to have to come from productivity improvements. productivity improvements are a challenge. the first thing we have to think about the ways -- is the ways our economy is not geared to that. improvements have to happen in a way that helps workers, not just employers. you can imagine ways that is not the case. there are enormous impediments to that kind of growth that are put in place by public policy. >> you don't think that countries like canada and australia provide models of sorts? they are interesting to read is in a different place than we are. have a different economy. they did not have the same sort of second half of the 20th
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century than we did. they have more low hanging fruit. austria is the same. we have a lot to learn from them. is not that the models are not important. but they do not have a solution we can simply adopt. >> one thing i want is to focus on is we can always have greater productivity. greater economic growth. we definitely want to encourage that. we have had productivity gamins over the last decade. but those gains are not being shared equally. the wealth and the economy is moving up. i don't want to harp on a lack of growth. we would like to have more growth. the growth we have had is moving almost exclusively to the top and an up the bottom -- the top end and not the bottom.
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that is a challenge of democracy. legal front economy -- if we go from an economy with 50% middle-class voters, to 40%, it is going to hurt politics. >> if you really want to help the middle class,, why not illuminate the payroll tax? -- eliminate the payroll tax? if you make $40,000, your pain a lot of money -- you are paying a lot of money. one of your author suggests that. >> i agree. payroll tax relief is the way to provide middle-class tax relief. it is a regressive tax. the resistance to it, happens on both left and right, comes from the fact that we think it is funding medicare and social security. anyway it does -- in a way, it does. in a way it does not.
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they are funded by the treasury. we have persuaded ourselves they are accounts that are held for social security and medicare. that is really not quite true. we can rethink that. if we laminated -- eliminate it, would have to rethink how they are funded to read >> i would agree. i think they are regressive. there are political challenges. if you would not create a tax on employment. -- if you started from scratch, you would not create what is essentially a tax on employment. my view, i think we should be getting, focusing on everything not only on employment issues. we should also thinking about how we can have drawn based wage growth -- broad-based wage growth. >> you have consulted with marco
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rubio, paul ryan. you met with jeb bush. his jeb bush on the same page as rubio and ryan? >> it is early to say. they are still formulating their policy positions and picking about where they are. he is thinking about the question of mobility. everybody running for president is going to be talking about that issue. that is where the economic date is going. i think that is a good thing. the parties have been talking past each other in the last 10 years. when have talked about the economy, they have talked about different rings. coming to a debate that is about how to enable mobility is a way to clarify the differences between the parties and help them think about the same questions. >> wilhelm hillary clinton -- wilhelm hillaryl hillary clinton
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talk more about this and less about how to revive clinton economics? >> both sides are going to test on these issues. every candidate. when hillary ran in 2008, she was talking about issues, the stagnant middle-class. those challenges have only become more pronounced. i imagine the challenge of the middle class and social mobility . a rising inequality. >> how optimistic for you both that it will be joined in 2016 and produce result afterwards? >> i work in policy. i have to believe policy will matter in the election. this is not an election where the income it the question. there's no incumbent. is going to be more policy driven. i think these questions will be front and center.
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with the eventual winner says is going to matter. >> i would agree. i think this selection like the past elections, we do not have -- is going to be about the future. who has a better answer to the struggles families are facing. we live in cynical times. both sides are going to have to break through with real ideas. >> what better place than an agreement between two of the most important policy architects. thank you for being with us and thank you for joining us. we will see you next time. ♪
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>> john: i'm john heilemann. mark: and i mark halperin. we are at a disclosed location somewhere outside the nation's capital, and that's right, we are talking about cpac, ladies and gentlemen. right now, scott walker is speaking, he is on stage here at cpac, and if you want to watch him live, you can head over to

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